| NPI | 1285078345 |
|---|---|
| Former Name | KIMBERLY DAWN REYNOLDS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: NC 12100) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: NC 3100) |
| Enumeration Date | 2013-04-19 |
| Last Update Date | 2022-04-22 |